Reproductive health

Menopause

Definition of Menopause

WHO 2004 defined natural menopause (the permanent cessation of menstruation resulting from loss of ovarian follicular activity which occurred after 12 consecutive months of amenorrhea).

Climacteric is defined as (the phase in the aging

women which marks the transition from reproductive state to non reproductive state).

Definitions Related to Menopause

Perimenopause :(1-2 year immediately before menopause or it is the whole reproductive period prior menopause ,it is characterized by menstrual irregularities )

Post menopause :(dating from the menstrual period regardless of wither the menopause was induced or spontaneous)

Importance of Topic

Menopausal women at more risk to develop cardiovascular diseases and osteoporosis on the long term effect, which affect the quality of life.

Menopausal women complaining from morbidity including urinary incontinence , urinary tract infections , reproductive infections and genital prolap.

Importance of Topic

little attention is provided to the menopausal women ,here in Jordan there isn’t available services to the menopausal women, because most of the health care focuses on the pregnant women during childbearing years, as the essential role of the woman is childbearing(Mahadeen, et al., 2008).

Age of Menopause

Worldwide the average age of menopause is 50yeras with a range of 45-55yeras.

The median age of menopause in Jordan is 50-51years, Jordanian women are living longer than their male counterparts with a life expectancy of 71 years (Jordan Department of Statistics 2005).

Menopause is affected by the woman's health , weight ,nutrition, life style ,culture and genetic factors.

Factors Affecting Menopause

Self concept Physical health Marital stability Relationship with others Cultural values Education

Research finding Among Jordanian Women

In a qualitative research done by(Mahadeen, et al., 2008) of 25 peri menopausal Jordanian women to study their perception of menopausal transition , they found that Jordanian women considered menopause as a life transition with no reproduction leading to a stage of freedom, relief and rest, Jordanian women valued the menopausal stage and consider it as a stage of wisdom ,so their perception was positive(Mahadeen, et al., 2008).

Becoming menopausal decreased women worries about pregnancy and gave them time to pray regularly and fast all the month of Ramadan without any interruption, therefore Jordanian women tended to have positive attitude toward menopause (Gharaibeh, et al., 2010).

Menopausal Symptoms

Vasomotor symptoms Vaginal symptoms Urinary symptoms Physical symptoms Psychological symptoms

Remember

Menopause is highly individualized and each women dealing with it in different way, although the biological changes are same , the symptoms vary in intensity ,frequency and severity from one women to another. There is short term symptoms and long term symptoms.

Vasomotor Symptoms

Hot flashes Night sweats Sweating Palpitations Insomnia, sleeping disturbances Shivering Increased pulse Feeling faint and nausea

Vaginal and Urinary Symptoms

Vaginal infection Post_ coital bleeding Painful sex Itching or irritation Decreased libido Decrease lubrication Urinary frequency /urgency Stress and urge incontinence

Physical Symptoms

Decreased fitness and flexibility

Changes in distribution of body fat

Changes in sleep patterns

Psychological Symptoms

Nervousness Anxiety Moody changes Irritability, confusion Depression Forget fullness Poor self esteem Deterioration in memory Psychosexual dysfunction

Long Term Symptoms

Cardiovascular symptoms which is considered as the leading cause of death in women and its incidence increased after menopause, increased risk for coronary heart diseases(CHD) hypertension and strokes.

Risk Factors for CHD

Family history of heart diseases Advancing age Overweight and obesity Cigarette smoking Hypertension Diabetes Elevated cholesterol

Osteoporosis

One in three of all

women develops

Osteoporosis The incidence increases

in post menopause

due to the reduction

in estrogen levels

Risk Factors for Osteoporosis

Personal history of fracture Current low bone mass Advanced age Family history of osteoporosis Low intake of calcium Vitamin D deficiency Cigarette smoking Inactive life style

Remember

Negative attitudes toward menopause affect the severity of menopausal symptoms, therefore nurses need to reassure the women about normalcy of menopause to make coping and adaptation.

Management of Menopause

life style changesComplementary treatmentHormonal Replacement

Therapy (HRT)

life Style Changes

Regular exercises to prevent coronary heart diseases

lowering weight to increase bone density Avoidance of stress and stressful situation Decrease in caffeine and alcohol intake Smoking cessation Proper nutrition Being in the sun light taking vitamins and calcium

life Style Changes

To use appropriate moisture

to manage any vaginal dryness

Keep cool patches and sprays under

pillows at night to help manage hot flushes and night sweats

Complementary Therapy

Acupuncture Homeopathy Aromatherapy Massage Use of herbs Cognitive behavior therapy Group therapy

Hormonal Replacement Therapy (HRT)

It is effective to relieve vasomotor

urogenital and psychological

symptoms . It is available in many forms and

a variety of routes , including oral

transdermal and intrauterine.

Remember

• Estrogen alone is given to women who

undergone hysterectomy , it increased the

risk of endometrial cancer.

• Progesterone and estrogen given to

women with intact uterus.

Hormonal Replacement Therapy (HRT)

The current advice is to use the lowest dose for the shortest possible time ,many women who stop HRT find that symptoms return again.

Before Starting HRT

Pap smearMeasurement of cholesterol,

lipids ,liver enzymesBase line mammogramEndometrial biopsy

Hormonal Replacement Therapy (HRT)

HRT is contraindicated in women with recent thromoemboilitic disease or sever liver disease, in special forms and in certain circumstances , it will increase the risk of breast cancer in women aged above 50 years , and also older patients who are taking certain types of HRT may also be at increased risk of ischemic stroke.

References

Agnew, Y. (2010). Dealing with menopause -- Go with the flow. Sister Namibia, 22(2), 11-11. Brockie, J. (2008). Physiology and effects of the menopause. Nurse Prescribing, 6(5), 202-207. Gharaibeh, M., Al-Obeisat, S., & Hattab, J. (2010). Severity of menopausal symptoms of Jordanian

women. [Article]. Climacteric, 13(4), 385-394. doi: 10.3109/13697130903050009 Holloway, D. (2011). An overview of the menopause: assessment and management. Nursing Standard,

25(30), 47-58. Mahadeen, A. I., Halabi, J. O., & Callister, L. C. (2008). Menopause: a qualitative study of Jordanian

women's perceptions. [Article]. International Nursing Review, 55(4), 427-433. doi: 10.1111/j.1466-7657.2008.00662.x

Pitkin, J. (2010). Cultural issues and the menopause. Menopause International, 16(4), 156-161. doi: 10.1258/mi.2010.010032

Senba, N., & Matsuo, H. (2010). Effect of a health education program on climacteric women. Climacteric: The Journal Of The International Menopause Society, 13(6), 561-569.

Strauss, J. R. (2011). Contextual Influences on Women's Health Concerns and Attitudes toward Menopause. Health & Social Work, 36(2), 121-127.

Yangin, H. B., Kukulu, K., & Sozer, G. A. (2010). The Perception of Menopause Among Turkish Women. [Article]. Journal of Women & Aging, 22(4), 290-305. doi: 10.1080/08952841.2010.518880

 

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